Endoscopy 2019; 51(04): S19-S20
DOI: 10.1055/s-0039-1681225
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: EUS diagnosis Club D
Georg Thieme Verlag KG Stuttgart · New York

YIELD OF MALIGNANT LYMPH NODE DETECTION BY EUS AND FNA IN RESTAGING AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER

RD van der Bogt
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
BJ van der Wilk
2   Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
JW Poley
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
KK Krishnadath
3   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
EJ Schoon
4   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands
,
LE Oostenbrug
5   Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Heerlen, Netherlands
,
PD Siersema
6   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
,
FP Vleggaar
7   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
,
K Biermann
8   Department of Pathology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
JJB van Lanschot
2   Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
MCW Spaander
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Despite the known decreased accuracy, endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) are believed to be potential tools for detection of residual disease after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer. This study aimed to investigate the yield of EUS and FNA for detection of malignant lymph nodes after nCRT.

Methods:

EUS and FNA were performed 12 weeks after completion of nCRT. Suspect lymph nodes were defined as round, hypo-echogenic, and with a size of ≥5 millimetres. Lymph nodes that were considered suspect but did not meet aforementioned criteria were recorded separately. To guide targeting of suspect lymph nodes, F18-FDG PET-CT was performed beforehand. Endoscopic nodal staging by EUS (uN) was compared to the histopathological examination of the resection specimen (ypN). Primary outcome of this study was the proportion of patients with malignant lymph nodes (ypN+) that was identified by EUS (uN+).

Results:

100 consecutive patients were included in this analysis. Tumour was passable in all patients. Twenty-one patients had ypN+ residual disease of which 11 were identified by EUS (sensitivity 52%). Subsequently, 62 of 79 ypN- patients were classified accordingly by EUS (specificity 78%). More than half of patients (n = 6, 55%) in whom suspect lymph nodes did not meet predefined criteria had ypN+ residual disease. Missed malignant lymph nodes were located at the coeliac trunk, the lesser curvature, and at the paraoesophageal stations. Sensitivity and specificity of FNA were 75% (3/4) and 100% (11/11), respectively. FNA outcome was uncertain in 8 patients. A positive aspirate was collected in one FDG-avid lymph node that was deemed benign by EUS.

Conclusions:

Only half of patients with ypN+ residual disease was identified by EUS after nCRT. For this reason and the absence of false-positive findings by FNA, all lymph nodes detected after nCRT should be sampled when aiming to detect residual disease.